1760482756 NPI number — DR. RICHARD MATTHEW MCINTYRE D.C.

Table of content: DR. RICHARD MATTHEW MCINTYRE D.C. (NPI 1760482756)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760482756 NPI number — DR. RICHARD MATTHEW MCINTYRE D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCINTYRE
Provider First Name:
RICHARD
Provider Middle Name:
MATTHEW
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760482756
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3046 HARTSVILLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HENDERSON
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89052-8514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-914-6950
Provider Business Mailing Address Fax Number:
702-914-6950

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9555 S EASTERN AVE
Provider Second Line Business Practice Location Address:
SUITE 240
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89123-8008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-301-3862
Provider Business Practice Location Address Fax Number:
702-914-6950
Provider Enumeration Date:
07/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111NX0800X , with the licence number:  B 149 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 668342 . This is a "ANTHEM BCBS HMO, PPO" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".




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